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ETHNICITY AND FAMILY THERAPY
 Contributors

Nuha Abudabbeh, PhD, NAIM Foundation, Washington, DC

Anna M. Agathangelou, PhD, Department of Political Science, York University, Toronto,

Ontario, Canada

Rhea Almeida, PhD, LCSW, Institute for Family Services, Somerset, New Jersey; Multicultural
Family Institute, Highland Park, New Jersey

Zarita Araújo-Lane, MSW, LCSW, Cross Cultural Communication Systems, Inc., Winchester,
Massachusetts

Guillermo Bernal, PhD, University Center for Psychological Services and Research and
Department of Psychology, University of Puerto Rico, Rio Piedras, Puerto Rico

Lascelles Black, MSW, private practice, New Rochelle, New York, and New York, New York

James K. Boehnlein, MD, Department of Psychiatry, Oregon Health and Science University,
Portland, Oregon

Nancy Boyd-Franklin, PhD, Graduate School of Psychology, Rutgers, The State University of
New Jersey, Piscataway, New Jersey

Janet R. Brice-Baker, PhD, Department of Psychology, Yeshiva University, Bronx, New York

Mary Anne Broken Nose, BA, COPSA Institute for Alzheimer’s Disease and Related Disorders,
University of Medicine and Dentistry of New Jersey–University Behavioral HealthCare,
Piscataway, New Jersey

Steve Dagirmanjian, PhD, Catskill Family Institute, Kingston, New York

Sean D. Davis, PhD, Marriage and Family Therapy Program, Department of Family Studies,
University of Kentucky, Lexington, Kentucky

Conrad De Master, LCSW, private practice, Waldwick, New Jersey

Ann Del Vecchio, PhD, Alpha Assessment Associates, Albuquerque, New Mexico

Jenny Duncan-Rojano, MS, LCSW, School-Based Centers, Hartford Public Schools, Hartford,
Connecticut

Beth M. Erickson, PhD, Erickson Consulting, Edina, Minnesota, and Ramsey, Minnesota

ix
x ‫ﲄ‬ Contributors

Celia Jaes Falicov, PhD, Department of Psychiatry, University of California, San Diego, San
Diego, California
John Folwarski, LCSW, Raritan Bay Mental Health Center, Perth Amboy, New Jersey
Nydia Garcia-Preto, LCSW, Multicultural Family Institute, Highland Park, New Jersey
Rita Mae Gazarik, LCSW, private practice, New York, New York; Columbia University School
of Social Work, New York, New York; Hunter College School of Social Work, City University
of New York, New York, New York
Joe Giordano, MSW, private practice, Bronxville, New York
MaryAnn Dros Giordano, MSW, private practice, Bronxville, New York
Karen L. Haboush, PsyD, Graduate School of Applied and Professional Psychology, Rutgers,
The State University of New Jersey, Piscataway, New Jersey; private practice, Highland Park,
New Jersey
Miguel Hernandez, LCSW, Roberto Clemente Center, Sylvia Del Villard Program, Gouverneur
Healthcare Service, New York, New York; Ackerman Institute for the Family, New York, New
York
Paulette Moore Hines, PhD, Center for Healthy Schools, Families, and Communities and Office
of Prevention Services and Research, University of Medicine and Dentistry of New Jersey–
University Behavioral HealthCare, Piscataway, New Jersey; Multicultural Family Institute,
Highland Park, New Jersey
Vanessa Jackson, LCSW, private practice, Atlanta, Georgia
Behnaz Jalali, MD, Department of Psychiary, University of California, Los Angeles, Los
Angeles, California
Hugo Kamya, PhD, Graduate School of Social Work, Boston College, Boston, Massachusetts
Valli Kalei Kanuha, PhD, School of Social Work, University of Hawaii, Honolulu, Hawaii
Kyle D. Killian, PhD, Department of Family Therapy and Psychology, University of Houston–
Clear Lake, Houston, Texas
Bok-Lim C. Kim, MSW, private practice, San Diego, California
Joanne Guarino Klages, LCSW, Multicultural Family Institute, Highland Park, New Jersey;
private practice, Highland Park, New Jersey, and Staten Island, New York
Eliana Catão de Korin, DiplPsic, Department of Family and Social Medicine, Montefiore
Medical Center, Albert Einstein College of Medicine, Bronx, New York
Jo-Ann Krestan, MA, private practice, Center for Creative Change, Ellsworth, Maine
Daniel Kusnir, MD, New College of California School of Graduate Psychology, San Francisco,
California; La Familia Counseling Service, Hayward, California; Survivors International, San
Francisco, California
Pamela Langelier, PhD, Department of Family Medicine, College of Medicine, University of
New England, Biddeford, Maine; private practice, Saco, Maine
Régis Langelier, PhD, private practice, Saco, Maine
Tracey A. Laszloffy, PhD, Marriage and Family Therapy Program, Seton Hill University,
Greenberg, Pennsylvania
 Contributors ‫ﲄ‬ xi

Evelyn Lee, EdD (deceased), Richmond Area Multi Services, Inc., San Francisco, California

Paul K. Leung, MD, Department of Psychiatry, Oregon Health and Science University, Portland,
Oregon

Catherine D. M. Limansubroto, MS, private practice, Tangerang, Indonesia

Vanessa McAdams-Mahmoud, MSW, private practice and Director of Counseling, Spelman

College, Atlanta, Georgia

David W. McGill, PsyD, Couples and Family Center, Cambridge Hospital, Cambridge,
Massachusetts; Department of Psychiatry, Harvard Medical School, Cambridge, Massachusetts

Monica McGoldrick, LCSW, PhD (h.c.), Multicultural Family Institute, Highland Park, New
Jersey; Department of Psychiatry, University of Medicine and Dentistry of New Jersey–Robert
Wood Johnson Medical School, Piscataway, New Jersey

Lorna McKenzie-Pollock, MSW, MA, School of Social Work, Boston University, Boston,
Massachusetts; private practice, Brookline, Massachusetts

Josiane Menos, PsyD, Staten Island Office of Children and Family Services, Staten Island, New
York; New York City Department of Education, New York, New York; Multicultural Family
Institute, Highland Park, New Jersey

Marsha Pravder Mirkin, PhD, Women’s Studies Research Center, Brandeis University, Waltham,
Massachusetts; Lasell College, Newton, Massachusetts

Matthew R. Mock, PhD, Family, Youth, Children’s and Multicultural Services, Berkeley,
California; Graduate School of Professional Psychology, John F. Kennedy University, Orinda,
California; private practice, Berkeley, California

Shivani Nath, MS, Department of Professional Psychology and Family Therapy, College of
Education and Human Services, Seton Hall University, South Orange, New Jersey; Asian
American Federation of New York, New York

Leonid Newhouse, LCSW, private practice, Boston, Massachusetts

Barbara F. Okun, PhD, Department of Counseling and Applied Psychology, Northeastern

University, Boston, Massachusetts

John K. Pearce, MD, Psychiatric Group of the North Shore, Lynn, Massachusetts; Island
Counseling, Martha’s Vineyard, Massachusetts

Sueli S. de Carvalho Petry, PhD, Department of Psychology and Family Therapy, College of
Education and Human Services, Seton Hall University, South Orange, New Jersey; Multicultural
Family Institute, Highland Park, New Jersey

Fred P. Piercy, PhD, Department of Human Development, Virginia Polytechnic Institute and
State University, Blacksburg, Virginia

Vimala Pillari, DSW, LCSW, Graduate School of Social Work, Dominican University, River
Forest, Illinois

Ramón Rojano, MD, City of Hartford, Hartford, Connecticut; University of Connecticut School
of Community Medicine, Storrs, Connecticut; Marriage and Family Therapy Program, Central
Connecticut State University, New Britain, Connecticut; Institute for the Hispanic Family,
Hartford, Connecticut
xii ‫ﲄ‬ Contributors

Maria P. P. Root, PhD, private practice, Seattle, Washington

Elliott J. Rosen, EdD, private practice, Scarsdale, New York

Eunjung Ryu, LCSW, Department of Couples and Family Therapy, College of Nursing and
Health Professions, Drexel University, Philadelphia, Pennsylvania; private practice, Highland
Park, New Jersey
Ester Shapiro, PhD, Department of Psychology, University of Massachusetts, Boston,
Massachusetts
Tazuko Shibusawa, PhD, Columbia University School of Social Work, New York, New York
Joseph Smolinski, Jr., MSW, Psychotherapy and Spirituality Institute, New York, New York
Adriana Soekandar, MS, Mandiri School and private practice, Jakarta, Indonesia
CharlesEtta T. Sutton, MSW, LCSW, Multicultural Family Institute, Highland Park, New Jersey;
private practice, Plainfield, New Jersey; Turtle Island Project, Phoenix, Arizona
Nadine Tafoya, MSW, private practice, Espagnola, New Mexico
Morris Taggart, PhD, retired, Houston, Texas
Carmen Inoa Vazquez, PhD, private practice and Department of Psychiatry, New York
University School of Medicine, New York, New York
Susan F. Weltman, LCSW, private practice, Metuchen, New Jersey
Norbert A. Wetzel, ThD, Center for Family, Community, and Social Justice, Princeton, New
Jersey
Hinda Winawer, MSW, LCSW, LMFT, Center for Family, Community, and Social Justice,
Princeton, New Jersey; Ackerman Institute for the Family, New York, New York
Anat Ziv, MSc, private practice, Ra’anana, Israel
 Acknowledgments

M any people have supported us in our efforts to produce this third edition of Ethnic-
ity and Family Therapy, particularly Senior Editor Jim Nageotte and the staff at The
Guilford Press. Fran Snyder and Irene Umbel, at the Multicultural Family Institute, pro-
vided assistance both direct and indirect to make this book come to fruition.
I (M. M.) thank my husband, Sophocles Orfanidis, for the ongoing emotional and
physical support he has given me over more than 35 years, which have made my endeav-
ors, including this major life effort, possible. And I thank my Greek-Irish son, John, for
growing into such a wonderful man.
I (J. G.) want to thank my wife, MaryAnn, who generously has given her love, sup-
port, and clinical insights in all my professional and creative endeavors. I also want to
thank Irving Levine, my dearest friend and colleague for the past 35 years, for his contin-
ued counsel, and David Szonyi, whose help in editing this book was invaluable. And
finally, I am grateful to the Maurice Falk Medical Fund and the American Jewish Com-
mittee, whose financial and organizational support contributed to the success of this
book.
I (N. G.-P.) want to thank my children, Sara and David, for challenging my ideas
about culture, gender, and class, and my parents, who taught me to love and to be proud
of my Puerto Rican roots. I would also like to thank all the Latin American families who
have given me the opportunity to learn about the struggles and strengths of Latino immi-
grants in this country.
We are also deeply indebted to Mary Anne Broken Nose, who has for many years
been our major research consultant on materials for our work. We don’t know how this
edition would have come to fruition without her. Her positive energy, intelligence, and
skill in finding relevant materials were indispensable.
David McGill, a wonderful friend, came through as he always has, offering counsel
and specific suggestions regarding the book. His behind-the-scenes support was a major
factor in making this third edition possible.
And we thank the authors for all their efforts in providing so much creativity and
wisdom in their cultural descriptions. Some of them had to put up with our calls and cri-
tiques over and over again and we thank them for persevering. We owe a special debt to

xiii
xiv ‫ﲄ‬ Acknowledgments

those authors who helped out in a pinch by delivering a chapter in the nick of time when
we were at our wits’ end about filling in the gap for missing material. We also thank the
network of therapists and trainers who have participated in the Multicultural Family
Institute’s Annual Culture Conferences over the years, for the underlying support they
have given that is the subtext of all our work. They have given us roots and wings and we
would not be publishing this without their loyalty and ongoing challenges to our think-
ing.
We are very proud of the work of so many colleagues and hope the readers will
appreciate the efforts made by so many people to speak clearly and practically on a sub-
ject that is so very complex.
 Contents

1. Overview: Ethnicity and Family Therapy 1

Monica McGoldrick, Joe Giordano, and Nydia Garcia-Preto

I.
AMERICAN INDIAN AND PACIFIC ISLANDER FAMILIES

2. American Indian Families: An Overview 43

CharlesEtta T. Sutton and Mary Anne Broken Nose

3. Back to the Future: An Examination of the Native American 55

Holocaust Experience
Nadine Tafoya and Ann Del Vecchio

4. Na ‘Ohana: Native Hawaiian Families 64

Valli Kalei Kanuha

II.
FAMILIES OF AFRICAN ORIGIN

5. Families of African Origin: An Overview 77

Lascelles Black and Vanessa Jackson

6. African American Families 87

Paulette Moore Hines and Nancy Boyd-Franklin

7. African Immigrant Families 101

Hugo Kamya

8. British West Indian Families 117

Janet R. Brice-Baker

xv
xvi ‫ﲄ‬ Contents

9. Haitian Families 127

Josiane Menos

10. African American Muslim Families 138

Vanessa McAdams-Mahmoud

III.
LATINO FAMILIES

11. Latino Families: An Overview 153

Nydia Garcia-Preto

12. Brazilian Families 166

Eliana Catão de Korin and Sueli S. de Carvalho Petry

13. Central American Families 178

Miguel Hernandez

14. Colombian Families 192

Ramón Rojano and Jenny Duncan-Rojano

15. Cuban Families 202

Guillermo Bernal and Ester Shapiro

16. Dominican Families 216

Carmen Inoa Vazquez

17. Mexican Families 229

Celia Jaes Falicov

18. Puerto Rican Families 242

Nydia Garcia-Preto

19. Salvadoran Families 256

Daniel Kusnir

IV.
ASIAN FAMILIES

20. Asian Families: An Overview 269

Evelyn Lee and Matthew R. Mock

21. Cambodian Families 290

Lorna McKenzie-Pollock
 Contents ‫ﲄ‬ xvii

22. Chinese Families 302

Evelyn Lee and Matthew R. Mock

23. Filipino Families 319

Maria P. P. Root

24. Indonesian Families 332

Fred P. Piercy, Adriana Soekandar, Catherine D. M. Limansubroto,
and Sean D. Davis

25. Japanese Families 339

Tazuko Shibusawa

26. Korean Families 349

Bok-Lim C. Kim and Eunjung Ryu

27. Vietnamese Families 363

Paul K. Leung and James K. Boehnlein

V.
ASIAN INDIAN AND PAKISTANI FAMILIES

28. Asian Indian Families: An Overview 377

Rhea Almeida

29. Indian Hindu Families 395

Vimala Pillari

30. Pakistani Families 407

Shivani Nath

VI.
MIDDLE EASTERN FAMILIES

31. Arab Families: An Overview 423

Nuha Abudabbeh

32. Armenian Families 437

Steve Dagirmanjian

33. Iranian Families 451

Behnaz Jalali
xviii ‫ﲄ‬ Contents

34. Lebanese and Syrian Families 468

Karen L. Haboush

35. Palestinian Families 487

Nuha Abudabbeh

VII.
FAMILIES OF EUROPEAN ORIGIN

36. Families of European Origin: An Overview 501

Joe Giordano and Monica McGoldrick

37. American Families with English Ancestors from the Colonial Era: 520
Anglo Americans
David W. McGill and John K. Pearce

38. Dutch Families 534

Conrad De Master and MaryAnn Dros Giordano

39. French Canadian Families 545

Régis Langelier and Pamela Langelier

40. German Families 555

Hinda Winawer and Norbert A. Wetzel

41. Greek Families 573

Kyle D. Killian and Anna M. Agathangelou

42. Hungarian Families 586

Tracey A. Laszloffy

43. Irish Families 595

Monica McGoldrick

44. Italian Families 616

Joe Giordano, Monica McGoldrick, and Joanne Guarino Klages

45. Portuguese Families 629

Zarita Araújo-Lane

46. Scandinavian Families: Plain and Simple 641

Beth M. Erickson

47. Scots-Irish Families 654

Morris Taggart
 Contents ‫ﲄ‬ xix

VIII.
JEWISH FAMILIES

48. Jewish Families: An Overview 667

Elliott J. Rosen and Susan F. Weltman

49. Israeli Families 680

Anat Ziv

50. Orthodox Jewish Families 689

Marsha Pravder Mirkin and Barbara F. Okun

51. Russian Jewish Families 701

Leonid Newhouse

IX.
SLAVIC FAMILIES

52. Slavic Families: An Overview 711

Leonid Newhouse

53. Czech and Slovak Families 724

Jo-Ann Krestan and Rita Mae Gazarik

54. Polish Families 741

John Folwarski and Joseph Smolinski Jr.

APPENDIX. CULTURAL ASSESSMENT 757

AUTHOR INDEX 765

SUBJECT INDEX 776

 CHAPTER 1
‫ﲄ‬

Overview
Ethnicity and Family Therapy

Monica McGoldrick
Joe Giordano
Nydia Garcia-Preto

The future of our earth may depend on the ability of all [of us] to identify and develop
new . . . patterns of relating across difference.
—LORDE (1992, p. 502)

What would it be like to have not only color vision but culture vision, the ability to see
the multiple worlds of others?
—BATESON (1995, p. 53)

C ultural identity has a profound impact on our sense of well-being within our society
and on our mental and physical health. Our cultural background refers to our ethnicity,
but it is also profoundly influenced by social class, religion, migration, geography, gender
oppression, racism, and sexual orientation, as well as by family dynamics. All these fac-
tors influence people’s social location in our society—their access to resources, their
inclusion in dominant definitions of “belonging,” and the extent to which they will be
privileged or oppressed within the larger society. These factors also influence how family
members relate to their cultural heritage, to others of their cultural group, and to preserv-
ing cultural traditions. Furthermore, we live in a society in which our high rates of cul-
tural intermarriage mean that citizens of the United States increasingly reflect multiple
cultural backgrounds. Nevertheless, because of our society’s political, economic, and
racial dynamics, our country is still highly segregated; we tend to live in communities seg-
regated communities by race, culture, and class, which also have a profound influence on
our sense of ethnic identity.
It is now more than two decades since the first edition of Ethnicity and Family Ther-
apy was published; in these decades our awareness of cultural diversity in our society and

1
2 ‫ﲄ‬ 1. Overview: Ethnicity and Family Therapy

world has changed profoundly. We have witnessed amazing attempts at transforming eth-
nic group relationships in South Africa, Northern Ireland, the Middle East, and the for-
mer Soviet Union, as well as tragic ethnic devastation in the Sudan, Rwanda, Kosovo,
Russia, the Middle East, and Latin America. Meanwhile, the United States is being trans-
formed by rapidly changing demographics and has played a most ethnocentric role in
going to war in Iraq. This is a role it has unfortunately played in many other regions at
other times, most especially in Central and South America, in some of the Caribbean
island nations, the Phillipines, and Vietnam (see Chapters 11–19, 23, and 27).

THE MEANING OF ETHNICITY

Why have we as a people been able to continue to exist? Because we know where we
come from. By having roots, you can see the direction in which you want to go.
—JOENIA BATISTE DE CARVAHLO, first Indian woman lawyer in Brazil,
who is fighting for the rights of her people.
(New York Times, November 13, 2004, p. 7)

Having a sense of belonging, of historical continuity, and of identity with one’s own peo-
ple is a basic psychological need. Ethnicity, the concept of a group’s “peoplehood,” refers
to a group’s commonality of ancestry and history, through which people have evolved
shared values and customs over the centuries. Based on a combination of race, religion,
and cultural history, ethnicity is retained, whether or not members realize their common-
alities with one another. Its values are transmitted over generations by the family and
reinforced by the surrounding community. It is a powerful influence in determining iden-
tity. It patterns our thinking, feeling, and behavior in both obvious and subtle ways,
although generally we are not aware of it. It plays a major role in determining how we
eat, work, celebrate, make love, and die.
The subject of ethnicity tends to evoke deep feelings, and discussion frequently
becomes polarized or judgmental. As Greeley (1969) has described it, using presumed
common origin to define “we” and “they” seems to touch on something basic and pri-
mordial in the human psyche. Irving Levine (personal communication, February 15,
1981) observed: “Ethnicity can be equated along with sex and death as a subject that
touches off deep unconscious feelings in most people.” When there has been discussion of
ethnicity, it has tended to focus on nondominant groups’ “otherness,” emphasizing their
deficits, rather than their adaptive strengths or their place in the larger society, and how
so-called “minorities” differ from the “dominant” societal definitions of “normality.”
Our approach is to emphasize instead that ethnicity pertains to everyone, and influ-
ences everyone’s values, not only those who are at the margins of this society. From this
perspective cultural understanding requires examining everyone’s ethnic assumptions. No
one stands outside the category of ethnicity, because everyone has a cultural background
that influences his or her values and behavior.
Those born White, who conform to the dominant societal norms, probably grew up
believing that “ethnicity” referred to others who were different from them. Whites were
the definition of “regular.” As Tataki (1993, 2002) has pointed out, we have always
tended to view Americans as European in ancestry. We will not be culturally competent
until we let go of that myth. Many in our country are left with a sense of cultural home-
lessness because their heritage is not acknowledged within our society.
 1. Overview: Ethnicity and Family Therapy ‫ﲄ‬ 3

Our very definitions of human development are ethnoculturally based. Eastern cul-
tures tend to define the person as a social being and categorize development by growth in
the human capacity for empathy and connection. Many Western cultures, in contrast,
begin by positing the individual as a psychological being and define development as
growth in the capacity for autonomous functioning. Even the definitions “Eastern” and
“Western,” as well as our world maps (Kaiser, 2001), reflect an ethnocentric view of the
universe with Britain and the United States as the center.
African Americans (see Chapter 6; Boyd-Franklin, 2003; Carter, 1995; Franklin,
2004) have a very different foundation for their sense of identity, expressed as a commu-
nal sense of “We are, therefore I am,” contrasting starkly with the individualistic Euro-
pean ideal: “I think, therefore I am.” In the United States, the dominant cultural assump-
tions have generally been derived from a few European cultures, primarily German
(Chapter 40), Dutch (Chapter 38), and, above all, British (Chapter 37), which are taken
to be the universal standard. The values of these few European groups have tended to be
viewed as “normal,” and values derived from other cultures have tended to be viewed as
“ethnic.” These other values have tended to be marginalized, even though they reflect the
traditional values of the majority of the population.
Although human behavior results from intrapsychic, interpersonal, familial, socio-
economic, and cultural forces, the mental health field has paid greatest attention to the
first of these—the personality factors that shape life experiences and behavior. DSM-IV,
although for the first time considering culture in assessing and treating patients, allows
one to conduct the entire course of diagnosis and therapy with no thought of the patient’s
culture at all. Much of the authors’ work on culture was omitted from the published
manual, and the “culture-bound” syndromes they did mention tended to “exoticize the
role of culture” (Lopez & Guarnaccia, 2000). Indeed, the authors decided to exclude dis-
orders seen as primarily North American disorders (anorexia nervosa and chronic fatigue
syndrome) from the glossary of culture-bound syndromes because they wanted to restrict
the term to problems of “ethnic minorities” (Lopez & Guarnaccia, 2000)!
As things stand now, most mental health record-keeping systems do not even record
patients’ ethnic backgrounds, settling for minimal reference to race as the only back-
ground marker. No other reference is generally made to immigration or heritage. In the
broader mental health field, there was a great increase in attention paid to ethnicity in the
1980s. However, since then there has been a distinct retreat from attention to culture as
managed care, pharmaceutical, and insurance companies took control of most mental
health services and intentionally minimized attention to family, context, and even service
for those who cannot afford to pay. Since the early 1990s, the mental health professions
in general pay only lip service to the importance of cultural competence. The study of cul-
tural influences on human emotional functioning has been left primarily to the cultural
anthropologists. Yet they have preferred to explore remote cultural enclaves, rather than
examining culture within our own diverse society.
Even mental health professionals who have considered culture have often been more
interested in examining international, cross-cultural comparisons than in studying the
ethnic groups within our own society. Our therapeutic models are generally presented as
having universal applicability. Only recently have we begun to consider the underlying
cultural assumptions of our therapeutic models and of ourselves as therapists. And even
now, reference to “cultural competence” varies from complete acceptance to outright
derision (Betancourt, 2004).
4 ‫ﲄ‬ 1. Overview: Ethnicity and Family Therapy

We must incorporate cultural acknowledgment into our theories and into our thera-
pies, so that clients not of the dominant culture will not have to feel lost, displaced, or
mystified. Working toward multicultural frameworks in our theories, research, and clini-
cal practice requires that we challenge our society’s dominant universalist assumptions, as
we must challenge our other societal institutions as well in order for democracy to survive
(Dilworth-Anderson, Burton, & Johnson, 1993; Hitchcock, 2003; Pinderhughes, 1989).
It is unfortunate that society’s rules have made it difficult for us to focus our vision
on ourselves in this way, but it is essential if we are to become culturally effective clini-
cians. As Bernard Lewis (2002) has put it:

When things go wrong in our society, our response is usually to place the blame on external or
domestic scapegoats—foreigners abroad or minorities at home. We might ask a different ques-
tion: What did we do wrong? (pp. 22–23)

This question, which leads us to look in every situation to see what we contribute to
misunderstandings, is essential to expanding our cultural awareness. We must understand
where we have been and the cultural assumptions and blinders our own history has given
us before we can begin to understand those who are culturally different from us.
This book presents a kind of “road map” for understanding families in relation to
their ethnic heritage. The paradigms here are not presented as “truth,” but rather as maps
to some aspects of the terrain, intended as a guide for the explorer seeking a path. They
draw on historical traits, residues of which linger in the psyche of families many genera-
tions after immigration, long after its members have become outwardly “Americanized”
and cease to identify with their ethnic backgrounds. Although families are changing very
rapidly in today’s world, our focus here is on the continuities, the ways in which families
retain the cultural characteristics of their heritage, often without even noticing these pat-
terns. Of course, the clinical suggestions offered by the authors of this book will not be
relevant in every case, but they will, it is hoped, expand the readers’ ways of thinking
about their own clinical assumptions and the thinking of the families with whom they
work. Space limitations have made it necessary for us to emphasize characteristics that
may be problematic. Thus, we do not always present families in their best light. We are
well aware that this can lead to misunderstandings and feed negative stereotypes. We
trust the reader to take the information in the spirit in which it is meant—not to limit our
thinking, but to expand it.
There has been a growing realization since this book’s first edition that a positive
sense of ethnic and racial identity is essential for developing a healthy personal and
group identity, and for effective clinical practice. So far, more in the field of health care
than in mental health, the concept of “cultural competence” has begun to become an
accepted value. In recognition of the overwhelming evidence of racial and ethnic dis-
parities in health care, there is a beginning acknowledgment that with every illness and
on virtually every measure of functioning, the cultural disparities in health care are
staggering and it is time to rethink our cultural attitudes and to address these realities.
A new field of “cultural competence” in health care has been emerging, a field that
defines the “culturally competent health care system” as one that acknowledges the
importance of culture throughout the system and is vigilant in dealing with the dynam-
ics that result from cultural differences, the expansion of cultural knowledge, and the
adaptation of services to meet culturally unique needs (Betancourt, Green, Carrillo, &
Ananeh-Firempong, 2003).
 1. Overview: Ethnicity and Family Therapy ‫ﲄ‬ 5

This field of culturally competent health care seeks to identify sociocultural barriers
to health care and to address them at every level of the system, including the cultural con-
gruity of the interventions provided and the degree to which the leadership and
workforce reflect the diversity of the general population (Betancourt et al., 2003).
Within the mental health field, recognition of the importance of culture has been much
slower. Family therapy, which was rocked to its foundations by the feminist critique
(Luepnitz, 1992; McGoldrick, Anderson, & Walsh, 1989; Wheeler, Avis, Miller, & Chaney,
1985), has been moving toward an awareness of the essential dimension of culture as well as
gender. Unfortunately, most of the institutions in the field, such as the major training pro-
grams, the publications, and the professional organizations, still view ethnicity as an “add-
on” to family therapy, a “special topic,” rather than as basic to all discussion. Reactions to
the upsurge in “diversity” presentations at the annual Family Therapy Academy meetings
have included a frequently articulated request by members to “get back to basics.” In our
view there is no such thing as moving “back” to basics. Rather, we must re-envision the
“basics” from more inclusive perspectives, so that the cultural underpinnings of all thera-
peutic endeavors will inform our work, allowing us to deal theoretically and clinically with
all our clients (see the Appendix on cultural clinical assessment).
For many, the earlier editions of Ethnicity and Family Therapy provided an “ah
ha!”—a recognition of their own cultural background or that of spouses, friends, or cli-
ents. Still, when it was first written, we were all fairly naive about the meaning of culture
in our complex world. Some feared that our book reinforced cultural stereotypes, but we
believed then, and believe now, that exploring cultural patterns and hypotheses is essen-
tial to all our clinical work.
We also recognize that ethnicity is not the only dimension of culture. In this book we
illustrate how gender, socioeconomic status, geography, race, religion, and politics have
influenced cultural groups in adapting to American life. Knowing that no single book
could possibly provide clinicians with all they need to know to work with those who are
culturally different, we gave the authors of the chapters the following instructions:

We have become increasingly convinced that we learn about culture primarily not by learning
the “facts” of another’s culture, but rather by changing our attitude. Our underlying openness
to those who are culturally different is the key to expanding our cultural understanding. Thus,
cultural paradigms are useful to the extent that they help us recognize patterns we may have
only vaguely sensed before. They can challenge our long-held beliefs about “the way things
are.” Thus, we ask you to write your chapter with the following aims in mind:
1. Describe the particular characteristics and values of the group with some context of his-
tory, geography, politics, and economics as they are pertinent to understanding the pat-
terns of the group.
2. Emphasize especially values and patterns that are relevant for therapy—those an unin-
formed therapist might be most likely to misunderstand (e.g, related to problems, help
seeking, and what is seen as the “cure” when people are in trouble).
3. Describe patterns that relate to clinical situations, especially couple relationships; par-
ent–child issues, sibling relationships, three-generational relationships; how families
deal with loss, conflict, affection, homosexuality, and intermarriage.
4. Include relevant information on the impact of race, class and class change, religion, gen-
der roles, sexual orientation, and migration experiences.
5. Offer guidelines for intervention to facilitate client well-being, demonstrating respect
for both the historical circumstances and the current adaptive needs of families in the
United States at the beginning of the 2lst century.
6 ‫ﲄ‬ 1. Overview: Ethnicity and Family Therapy

Clinicians should never feel that, armed with a small chapter about another cultural
group, they are adequately informed to do effective therapy. The chapters that follow are
not intended as recipes for relating to other ethnic groups, which is far more influenced
by respect, curiosity, and especially humility, than by “information.” It has been said that
some individuals are blessed with a certain magic that enables them to break down the
natural reserve we all feel toward those of another language, another culture, another
economic stratum. This is the blessing we wish to impart to our readers.

THE COMPLEXITY OF ETHNICITY

If we look carefully enough, each of us is a “hodgepodge.” Developing cultural compe-

tence requires us to question the dominant values and explore the complexities of cultural
identity. All of us are migrants, moving between our ancestors’ traditions, the worlds we
inhabit, and the world we will leave to those who come after us. The consciousness of
ethnic identity varies greatly within groups and from one group to another. Many people
in the United States grow up not even knowing their ethnicity or being descended from
many different ethnic backgrounds. Our clinical work of healing may entail helping cli-
ents to locate themselves culturally so that they can overcome the sense of mystification,
invalidation, or alienation that comes from not being able to feel culturally at home in
our society. But everyone has a culture. As family therapists, we work to help clients clar-
ify the multiple facets of their identity to increase their flexibility to adapt to America’s
multicultural society. We help them appreciate and value the complex web of connections
within which their identities are formed and which cushion them as they move through
life. Our clients’ personal contexts are largely shaped by the ethnic cultures from which
they have descended.
For most of us, finding out who we are means putting together a unique internal
combination of cultural identities. Ethnicity is a continuous evolution. We are all always
in a process of changing ethnic identity, incorporating ancestral influences while forging
new and emerging group identities, in a complex interplay of members’ relationships with
each other and with outsiders. Every family’s background is multicultural, and all mar-
riages are, to a degree at least, cultural intermarriages. No two families share exactly the
same cultural roots. Each of us belongs to many groups. We need to find a balance that
allows us to validate the differences between us, while appreciating the common forces
that bind us together, because the sense of belonging is vital to our identity. At the same
time, the profound cultural differences between us must also be acknowledged. It is when
the exclusion of others becomes primary to group identity that group identity becomes
negative and dysfunctional, based on exclusion of others through moral superiority, such
as White supremacy groups, or on elite social status, such as secret societies. The multiple
parts of our cultural heritage often do not fit easily into the description of any one group.
In addition, to define oneself as belonging to a single ethnic group, such as “Irish,”
“Anglo,” “African American,” is to greatly oversimplify matters, inasmuch as the process
of cultural evolution never stands still. We are always evolving ethnically. We offer our-
selves as illustrations:
Monica: My Irish ancestors had roots in Celtic tribes, who probably came from what
is now Switzerland, and Viking communities in what is now Norway. My husband emi-
grated from Greece at age 19, his family having lived in Turkey for generations until the
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